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INFLUENZA VACCINE DECLINATION For SWEDISH/EDMONDS EFFECTIVE 10/01/10 All Swedish/Edmonds employees, physicians, licensed independent practitioners, volunteers, students and contractors will be offered
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How to fill out influenza vaccine declination
How to fill out an influenza vaccine declination:
01
Obtain the influenza vaccine declination form from your healthcare provider or employer.
02
Carefully read through the entire form to familiarize yourself with its content and purpose.
03
Fill in your personal information accurately and completely, including your full name, date of birth, and contact information.
04
Indicate the reason for declining the influenza vaccine by selecting the appropriate option provided on the form. Common reasons include medical contraindications or personal beliefs.
05
If the form requires additional explanation or documentation, provide the necessary details or attachments accordingly.
06
Sign and date the form to acknowledge your decision to decline the influenza vaccine.
07
Return the completed form to your healthcare provider or employer as instructed.
Who needs influenza vaccine declination?
01
Individuals who have medical contraindications to receiving the influenza vaccine may need to fill out an influenza vaccine declination form. These can include severe allergic reactions to vaccine components, a history of Guillain-Barré Syndrome, or compromised immune systems. It is important to consult with a healthcare professional for guidance in these cases.
02
In some workplaces or educational institutions, the influenza vaccine may be mandatory, but exemptions can be granted for valid reasons. Employees or students who are unable to receive the vaccine due to medical or religious reasons may be asked to fill out an influenza vaccine declination form.
03
Individuals who have personal beliefs or philosophical objections to vaccination may also need to complete an influenza vaccine declination form if they wish to decline the vaccine. It is important to note that policies regarding vaccine exemptions may vary depending on the institution or jurisdiction, so it is advisable to check with the relevant authorities or consult legal counsel if needed.
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What is influenza vaccine declination?
Influenza vaccine declination is when an individual chooses not to receive the influenza vaccine.
Who is required to file influenza vaccine declination?
Healthcare workers and individuals in certain industries may be required to file influenza vaccine declination.
How to fill out influenza vaccine declination?
Influenza vaccine declination forms can typically be filled out online or in person at the workplace.
What is the purpose of influenza vaccine declination?
The purpose of influenza vaccine declination is to document an individual's decision not to receive the influenza vaccine.
What information must be reported on influenza vaccine declination?
Information such as name, date, reason for declination, and signature may need to be reported on influenza vaccine declination forms.
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